Phase III study of Phlai capsules in the treatment of allergic rhinitis: A randomized, double-blind, placebo-controlled trial.

BACKGROUND: Preclinical studies demonstrated anti-inflammatory effects of Zingiber montanum (J.König) Link ex Dietr.(Phlai). However, its clinical effect on allergic rhinitis (AR) is not evident. OBJECTIVE: We sought to assess the efficacy and safety of Phlai for treating AR. METHODS: A phase 3, randomized, double-blind, placebo-controlled study was conducted. Patients with AR were randomized into three groups and received Phlai 100 mg or Phlai 200 mg or placebo once a day for four weeks. The primary outcome was a change in the reflective total five symptom score (rT5SS). The secondary outcomes were the change in the instantaneous total five symptom score (iT5SS), the reflective individual symptom scores (rhinorrhea, nasal congestion, sneezing, itchy nose, itchy eyes), Rhinoconjunctivitis Quality of Life-36 Questionnaire (RCQ-36) score, peak nasal inspiratory flow (PNIF), and adverse events. RESULTS: Two hundred and sixty-two patients were enrolled. Compared with placebo, Phlai 100 mg improved rT5SS [adjusted mean difference (aMD) -0.62; 95%CI -1.22, -0.03; p = 0.039], rhinorrhea (aMD -0.19; 95%CI -0.37, 0.002; p = 0.048), itchy nose (aMD -0.24; 95%CI -0.43, -0.05; p = 0.011), and itchy eyes (aMD -0.19; 95%CI -0.36, -0.02; p = 0.033) at week 4. Nasal obstruction, sneezing, iT5SS, overall RCQ-36 score, PNIF did not reach statistical significance. Phlai 200 mg did not bring additional benefits compared to 100 mg. Adverse events were similar among groups. CONCLUSIONS: Phlai was safe. At four weeks, there were small improvements in rT5SS, together with the individual symptoms of rhinorrhea, itchy nose, and itchy eyes.

Comparison of the clinical outcome of endoscopic push-through myringoplasty and microscopic overlay myringoplasty: matching co-variated designs.

BACKGROUND: The conventional microscopic overlayer myringoplasty is preferred because it allows a both hands technique, not reducing middle ear space, increasing the blood supply in the repaired area, and providing graft support; however, this technique may be troublesome for the novice surgeon during tympanomeatal flap elevation. Recently, the endoscopic push-through myringoplasty technique has developed. It provides better visualization of the hidden areas and does not require raising tympanomeatal flap. Therefore, the comparison of clinical outcomes between endoscopic push-through myringoplasty and conventional microscopic overlay myringoplasty technique was investigated. METHODS: A retrospective case-control hospital-based study was conducted using archival data from the patients who underwent myringoplasty between January 2015 and May 2021 at Srinagarind Hospital and Khon Kaen Hospital, Thailand. The medical records of patients who underwent endoscopic push-through technique or microscopic overlayer technique were chosen by simple randomization and matched 1:1 based on the air conduction threshold, air-bone gap, size of perforation, and experience of the surgeon. The two techniques were compared for clinical outcome success, including tympanic membrane closure, improved air conduction threshold, air-bone gap closure, and operation time duration. RESULTS: Medical records of 70 patients were retrieved and classified into 35 patients who underwent endoscopic push-through and 35 patients who underwent microscopic overlayer myringoplasty. The size of tympanic membrane perforation and preoperative audiometry were not significantly different between both groups (p > 0.05). The postoperative outcome in endoscopic technique revealed that the air-bone gap and the success rate of tympanic membrane closure were comparable with microscopic techniques (p = 0.420 and p = 0.156, respectively). The operation time was significantly shorter in the endoscopic technique (p < 0.05). Complications were found in one patient with otitis externa in the endoscopic technique group and one patient with graft lateralization in the microscopic technique group. CONCLUSIONS: Endoscopic push-through myringoplasty is an alternative minimally invasive technique that may allow the potential outcomes comparable with the microscopic overlayer myringoplasty and with a significantly shorter operation time.

The effective screening tools for detecting hearing loss in elderly population: HHIE-ST Versus TSQ.

BACKGROUND: Globally increasing number of elders is concerned. Hearing loss process in older adults cannot be avoided. An effective screening tool for hearing loss is essential for proper diagnosis and rehabilitation, which can improve QOL in older adults. METHODS: This prospective-diagnostic test study evaluates the diagnostic value of Thai version of the Hearing Handicap Inventory for Elderly Screening (HHIE-ST) and the Thai Single Question (TSQ) surveys in screening hearing disability in 1109 Thai participants aged 60 years and older in communities in four provinces in Thailand. The HHIE-ST consisted of 10 selected questions from the validated HHIE-Thai version. A TSQ survey was developed to have the same meaning as an English Single Question survey. The participants answered both questionnaires, and a standard audiometry test assessed with air conduction from 250 to 8000 Hz was included as a gold standard. RESULTS: The prevalence of hearing disability was 38.34%. The HHIE-ST achieved a sensitivity of 88.96% (95% CI 85.77-91.64) and specificity of 52.19% (95% CI 48.24-56.13) for diagnosis hearing disability in Thai older adults, whereas the TSQ yielded a sensitivity of 88.73% and a specificity of 55.93%. A combined test including the HHIE-ST and TSQ achieved better performance with sensitivity of 85.29% and specificity of 60.13%. CONCLUSIONS: Either the HHIE-ST or the TSQ is a sensitive and useful tool for screening hearing disability in Thai older adults. Using the HHIE-ST together with the TSQ resulted in a better screening tool for detecting moderate hearing loss older adults who will benefit and recommended for hearing rehabilitation. TRIAL REGISTRATION: The study is registered with the following number in the Thai Clinical Trials Registry: TCTR20151015003 . Date of registration October 14, 2015.

Effectiveness of a programable body-worn digital hearing aid for older adults in a developing country: a randomized controlled trial with a cross-over design.

BACKGROUND: Hearing aids are important assistive devices for hearing rehabilitation. However, the cost of commonly available commercial hearing aids is often higher than the average monthly income of individuals in some developing countries. Therefore, there is a great need to locally produce cheaper, but still effective, hearing aids. The Thai-produced P02 hearing aid was designed to meet this requirement. OBJECTIVE: To compare the effectiveness of the P02 hearing aid with two common commercially available digital hearing aids (Clip-II™ and Concerto Basic®). METHODS: A prospective, randomized controlled trial with a cross-over design was conducted from October 2012 to September 2014 in a rural Thai community. There were 73 participants (mean age of 73.7 ± 7.3 years) included in this study with moderate to severe hearing loss who were assessed for hearing aid performance, including probe microphone real-ear measurement, functional gain, speech discrimination, and participant satisfaction with the overall quality of perceived sound and the design of the device. RESULTS: There were no statistically significant differences in functional gain or speech discrimination among the three hearing aids evaluated (p-value > 0.05). Real-ear measurements of the three hearing aids met the target curve in 93% of the participants. The best real-ear measurement of the hearing aid following the target curve was significantly lower than that of Clip-II™ and Concerto Basic® (p-value < 0.05) at high frequency. However, participants rated the overall quality of sound higher for the P02 hearing aid than that of Clip-II™ but lower than that of Concerto Basic® (p-value > 0.05). Participants revealed that the P02 hearing aid provided the highest satisfaction ratings for design and user-friendliness with statistical significance (p-value < 0.05). CONCLUSION: The P02 hearing aid was an effective device for older Thai adults with hearing disabilities. Additionally, its modern design, simplicity of use, and ease of maintenance were attractive to this group of individuals. These benefits support the rehabilitation potential of this hearing aid model and its positive impact on the quality of life of older adults in developing countries. TRIAL REGISTRATION: This study was registered under Clinicaltrial.gov NCT01902914 . Date of registration: July 18, 2013.

Comparison of quality of life between patients undergoing trans-oral endoscopic thyroid surgery and conventional open surgery.

BACKGROUND: Trans-oral endoscopic thyroidectomy allows obviating scar of the neck that expects to gain quality of life (QOL). However, the benefit of the QOL from this technique has not been adequately investigated, therefore, this study compared the QOL outcomes, including cosmetic outcomes, between thyroidectomy by trans-oral endoscopy and conventional open surgery. METHODS: A study was conducted from January 30, 2017 to November 10, 2018. Thirty-two and 38 patients underwent trans-oral endoscopic thyroid surgery and conventional open surgery, respectively. Their quality of life was evaluated at 2, 6, and 12 weeks postoperatively using a thyroid surgery-specific questionnaire and a 36-item short-form questionnaire. RESULTS: Trans-oral endoscopic group, patients were younger and presented with smaller thyroid nodules (p < 0.05). Regarding surgical outcomes, there were no statistically significant differences between the two groups. Mean operative time was significantly longer in the trans-oral endoscopic group (p < 0.05). The quality of life parameters in the trans-oral endoscopic group was significantly better than in the conventional surgery group (p < 0.05). These parameters included reduction of physical activity, psychosocial impairment, the role of physic, and emotion at 2 weeks after surgery; swallowing impairment, psychosocial impairment, the role of physic, social function and mental health 6 weeks after surgery; tingling and feeling of vitality at 12 weeks after surgery. Cosmetic outcomes and overall satisfaction were significantly better in the trans-oral endoscopic group than in the conventional surgery group at all of our follow up times (p < 0.05). CONCLUSIONS: The trans-oral endoscopic approach allows real scarless on the skin with better cosmetic and QOL outcomes. TRIAL REGISTRATION: This trial was retrospectively registered at the ClinicalTrial.gov (NCT03048539), registered on 4 March 2017.

Modified equipment for facilitating the transoral vestibular approach to endoscopic thyroidectomy.

OBJECTIVES: The objectives of the study were to investigate the improvement in operation time for thyroid surgery gained using a modified endobag and suture and to accelerate the learning process for novice endoscopic surgeons. MATERIALS AND METHODS: A retrospective study was conducted between 2 June 2015 and 1 November 2018. Medical records of patients who underwent transoral endoscopic thyroidectomy vestibular approach (TOETVA) were retrieved and analysed. Comparisons of operative time with or without the use of modified equipment were calculated by the unequal variance t-test in lobectomy and isthmectomy groups. RESULTS: Medical records of 102 patients (mean age: 39.1 years) were analysed. The size of thyroid nodule averaged 4.0 cm (range: 1.0-13.0 cm). TOETVA was applied for right lobectomy (57.8%), left lobectomy (34.3%), isthmectomy (3.9%) and total thyroidectomy (3.9%). Early in our experience, TOETVA required 168 min, whereas following the introduction of the modified endobag and extracorporeal suture, operative time was reduced to 30 min (P > 0.05). CONCLUSIONS: The use of modified equipment permitted shorter operation times. The time difference was not statistically significant but does represent a significant time-saving. The use of the modified equipment will simplify and speed up the learning process for novice endoscopic surgeons.

Configuration of the Ethmoidal Roof: A Radiologic Anatomical Study

Background: Currently endoscopic sinus surgery is the standard operation for rhinosinusitis and nasal polyps, including tumors near the anterior skull base. During the surgery, the iatrogenic penetration into the anterior skull base may be at risk. Therefore, information of the anterior skull base configuration is useful for the sinus surgeon. Objective: To determine the patterns and their prevalence of slopes of the ethmoidal roof assessed from the Computed Tomography (CTs) of paranasal sinuses. Material and Method: A descriptive study was conducted at Srinagarind Hospital, Faculty of Medicine, Thailand. CTs of paranasal sinuses from 150 patients aged 18 years and above who had attended at Srinagarind hospital between January 1, 2007 and December 31, 2011 were retrieved and reviewed. The slope patterns of the ethmoidal roof were determined by visual assessment of the scans, measuring the height between the ethmoidal roof and floor of nasal cavities in three sagittal planes: medio-sagittal, latero-sagittal, and mid-sagittal. CTs were performed by a Philips 128 slice scanner. Results: The downslope anteriorly and upslope posteriorly of the ethmoidal roof was found to be commonest in medio-sagittal and mid-sagittal planes. Its prevalence in medio-sagittal and mid-sagittal planes was 80.3% (95% CI 75.5-84.4) and 52% (95% CI 46.4-57.6). The second common pattern in medio-sagittal and mid-sagittal planes was a downslope pattern with the prevalence of 13% (95% CI 9.7-17.3) and 39.3% (95% CI 34-44). The downslope pattern was found to be the most prevalent for the latero-sagittal plane, accounting for 50.7% (95% CI 45.0-56.3), followed by downslope anteriorly and upslope posteriorly of 40% (95% CI 34.6-45.6). Conclusion: This is the first study to describe the patterns of slopes of the ethmoidal roof (anterior skull base) which demonstrates that there are different patterns depending on the plane of sagittal view. Therefore, the sagittal view of the CT paranasal sinus in each plane should be interpreted before performing the operation to avoid iatrogenic intracranial complications.

Ear, Nose, Throat and Craniofacial Diseases Community Services Initiative of Khon Kaen University.

The Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University has cooperated with the local community to establish the welfare and health education service in the local community. The first initiative was carried out in the local primary school. This paper described the missions, method and results of our first attempt to screen the students in the community.

Cleft Lip Cleft Palate and Craniofacial Deformities Care: An Anesthesiologist's Perspective at the Tawanchai Center.

BACKGROUND: The increasing number of pediatric patients with cleft lip-palate and craniofacial anomalies is a nuisance problem in the Northeast of Thailand. These patients have complicated problems including physical health, psychosocial, and poor quality of life; therefore, a multidisciplinary care team was established, named Tawanchai center. This study encouraged the improvement of the quality of holistic healthcare service system to improve the quality of life the patients and their families. Anesthesiologists are important personnel in the facilitation of the surgical team, and to help improve other activities including academic, service and research. OBJECTIVE: To relate the perspective of anesthesiologist according to the role they play in the multidisciplinary team. MATERIAL AND METHOD: The database of Anesthesiology department and annual report from the period between June 2005 to July 2015 were collected and reviewed. CONCLUSION: Highly-skilled and experienced anesthesiologist in the multidisciplinary patient care team play a vital role through the provision of advanced and specific knowledge to anesthesia management. The role of anesthesiologists should be researched to enhance the quality of anesthesia management, thereby contributing to national and international patient care team development.

Baby Shampoo versus Commercial Anti-fogging Solution to Prevent Fogging during Nasal Endoscopy: A Randomized Double-Blinded, Matched-Pair, Equivalent Trial.

OBJECTIVE: To compare the minimization of the fog condensation during nasal endoscopy between a commercial anti-fogging agent and baby shampoo. MATERIAL AND METHOD: This randomized double-blinded matched pair study was conducted at the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University during February 4, 2013 to March 14, 2013. The commercial anti-fogging solution (Ultrastop®) and baby shampoo solution (Johnson's® no more tear®) were compared. A computer generated randomization was performed to select the solution applying on the lens for nasal endoscopy of the right nasal cavity. The other solution was then used for the left one. Three passes of endoscopy were performed to examine the floor of the nose, the sphenoethmoidal recess and the middle meatus area which spent about 30 seconds for each time of endoscopy. The time to become foggy on the lens and the preferred solution assessed by the endoscopists were recorded. RESULTS: There were 71 eligible patients recruited in the study, 37 males (52.1%) and 34 females (47.9%). There was no fogging during a 30-second nasal endoscopy either by baby shampoo or commercial anti-fogging solution. However, 9.86% (95% C12.75-16.97) of endoscopists preferred commercial anti-fogging agent, 7.04% (95% CI 0.94-13.14) preferred baby shampoo and 83.10% (95% CI 74.16-92.03) had equal satisfaction. Both agents had no statistically significant difference for preventing foggy on the lens. CONCLUSION: Baby shampoo is an effective agent to prevent fogging during nasal endoscopy and comparable with the commercial anti-fogging agent.

Congenital Malformations of the Inner Ear: Case Series and Review of the Literature.

Patients with craniofacial anomalies often present to doctors due to their noticeable disfigurement and are routinely assessed by otolaryngologists for hearing evaluation. However, small percentage of craniofacial anomaly patients may present with delayed speech though they may not have initial obvious external deformation. The objective of case series is to identify the congenital inner ear malformation. The series of clinical presentation, physical examination, investigations, treatments and follow-up results were demonstrated followed by the discussion.

Community-Based Hearing Screening of Disabled Elders Using the Thai-FMHT: Clinical Implications and Cost-Effectiveness.

OBJECTIVE: The aim of this study was to evaluate the feasibility of using the two-stage hearing test to detect hearing disabilities in the community elders. MATERIAL AND METHOD: A prospective cohort study was conducted in the Phuwieng District, Khon Kaen, Thailand from December 1, 2012 to January 31, 2013. All of the elders more than 60 years of age were invited. First, screening using the Thai version of five-minute hearing test (Thai-FMHT) with a score equal to or greater than 12 was included in the group and then given the next audiometric examination. RESULTS: Two hundred fifty-eight elders were interested in this program, but only 192 subjects consented to participate in the entire study. Six participants withdrew before completing the protocol; therefore, 107 males and 79 females were included. The age ranged 60-92 years old. Only 152 participants (81.7%; 95% CI: 75.5-86.6%) had a hearing disability that could be rehabilitated using a hearing aid. The cost of hearing screening using this program was reduced from $114.15 to $28.60 per positive case with the need for hearing rehabilitation. CONCLUSION: The two-stage hearing screening using the Thai-FMHT followed by an audiometric examination was found to be a suitable test for community-based mass screening of hearing loss, particularly in an area with limited resources.

Anesthetic Techniques and Perioperative Complications of Cleft Lip and Cleft Palate Surgery at Srinagarind Hospital.

BACKGROUND: Cleft lip (CL) and cleft palate (CP) are common craniofacial abnormalities with an incidence of around 1:800. Surgical are corrections often performed during the first year of life. These patients have risks for difficult intubation and various perioperative complications due to their young age and craniofacial abnormalities. OBJECTIVE: The purpose of the retrospective descriptive study is to report the data of anesthetic techniques and complications of repairing CLCP in Srinagarind Hospital. These results could improve the caring and services for these groups of patients. MATERIAL AND METHOD: Data was retrieved from anesthetic records of patients undergoing correction of CLCP from the period January 2005 to January 2009. Demographic data, clinical diagnosis, type operation, anesthetic technique, total opiod were analyzed using direct laryngoscopic view, grading intubation, method of intubation, and as well perioperative complications were also analyzed. RESULTS: A total of 469 anesthetic records were obtained. The most common type of CLCP was unilateral side (45.48%). The highest incidence of difficult intubation was found in the CP and unilateral CLCP subgroup (4.48% and 4.48%, respectively). All patients were successfully intubated with a stylet except one patient, in whom retrograde intubation was used. Perioperative complications included desaturation, reintubation, postoperative bleeding, and post-operative nausea and vomiting (PONV). And the highest incidence of PONV was found in the CP (8.95%). Correlation between fentanyl using and postoperative desaturation was statistically significant when multivariate analysis was used (OR = 1.2; p = 0.01). CONCLUSION: Patients with unilateral CLCP or CP had a higher risk for difficult intubation. Fortunately, all of the patients were successfully intubated with advanced anesthetists' skill. Long operative periods and a large dose of opioid could contribute to the postoperative desaturation and PONV.

Validation of the Thai five-minute hearing test to screen hearing loss in the community.

BACKGROUND: Hearing impairment affects communication, social interactions, and quality of life. Audiometry is the gold standard method for hearing assessment. However, it is impractical in a country with limited resources. This study aimed to validate the Thai version of the Five-Minute Hearing Test (Thai-FMHT) to screen hearing loss in the community. METHODS: This prospective cohort study was conducted in Phu Wieng district, Khon Kaen Province, Thailand during July to September 2011. Subjects who were older than 18 years, could read or understand the Thai language, and wanted to participate were enrolled. Those who had aphasia, severe mental disability, or other conditions that precluded audiometry were excluded. The Thai-FMHT was first administered, followed by standard audiometry performed by audiologists who were blinded to the result of Thai-FMHT, and finally an ear examination was performed. This trial was registered with ClinicalTrial.gov as No. NCT01408992. RESULTS: The 558 subjects, including 176 males (32%) and 382 females (68%), completed all of the procedures. The optimal cutoff point for hearing loss in this screen was 8. The sensitivity, specificity, and positive likelihood ratio of the Thai-FMHT to screen mild hearing loss (PTA0.5-2 kHz >25 dB) were 64.7% (95% CI, 56.1-72.7%), 60.0% (95% CI, 55.1-64.7%), and 1.62 (95% CI, 1.36-1.92), respectively. Regarding screening moderate hearing loss (PTA0.5-2 kHz >40 dB), the sensitivity, specificity, and positive likelihood ratio of the Thai-FMHT were 93.1% (95% CI, 77.2-99.2%), 56.5% (95% CI, 55.1-64.7%), and 2.1 (95% CI, 1.9-2.5), respectively. CONCLUSION: The Thai-FMHT has a lower cutoff point than does the original one. This test is suitable for use as a screening tool for hearing loss in the community.

App-Based Hearing Screenings in Preschool Children With Different Types of Headphones: Diagnostic Study.

Background: Hearing disability in preschool children can delay or impact oral communication and social skills. Provision of hearing screening tests by standard audiometry in low- to middle-income countries is problematic due to a lack of pediatric audiologists, standard hearing equipment, and standard soundproof rooms. Therefore, an innovative hearing screening tool that is easily accessible and inexpensive such as a mobile app should be considered. Headphones have been a crucial part of hearing screenings. Audiometric headphones, which serve as the reference standard, have been used in most studies. However, since audiometric headphones are not accessible in rural areas, we hypothesized that generic headphones can also be used in hearing screenings. Objective: This study aimed to determine the sensitivity, specificity, κ coefficiency, and time consumption of the PASS-Pro (Preschool Audiometry Screening System-Pro) app when using TDH39 headphones, Beyerdynamic DT 770 PRO headphones, and generic earmuff headphones compared to standard conditioned play audiometry. Methods: We recruited preschool children aged 4 to 5 years to participate in this study. The children received 3 PASS-Pro screening tests using different types of headphones in a quiet room and 1 standard conditioned play audiometry in a soundproof room. All tests were administered in random order. The agreement coefficient, sensitivity, specificity, and mean test duration were determined. Results: A total of 44 children participated in this study. For mild hearing loss screening, the κ coefficients between standard conditioned play audiometry and the PASS-Pro app using TDH39 headphones, Beyerdynamic DT 770 PRO headphones, and generic earmuff headphones were 0.195, 0.290, and 0.261 (P=.02, P=.002, and P=.004), respectively. The sensitivity for all headphones was 50% and the specificity was more than 88%. For moderate hearing loss screening, the κ coefficients were 0.206, 0.272, and 0.235 (all Ps=.001), respectively. The sensitivity for all headphones was 100% and the specificity was more than 92%. There were no statistical differences in sensitivity and specificity between the reference headphone (TDH39), Beyerdynamic DT 770 PRO headphone, and generic earmuff headphones (all Ps >.05). The PASS-Pro app used significantly less time to carry out hearing tests than conditioned play audiometry (P<.001). Conclusions: The PASS-Pro app, used with generic headphones, is effective for conducting hearing screening tests in preschool children with high sensitivity and specificity.

An in vitro model and the underlying pathways of sinonasal inverted papilloma development.

Recently, the specific association between Sinonasal inverted papilloma (SIP) and EGFR exon 20 mutations has been reported. To investigate the link between specific EGFR mutations and SIP development, we established organotypic raft culture system using nasal polyp-derived immortalized NP2 (iNP2) cells expressing EGFR exon 20 mutants or an exon 19 mutant, and SIP-derived iIP4 cells harboring P772_H773insPYNP mutation. In the raft culture, iIP4 cells showed the inverted growth pattern characteristic to SIP. Interestingly, iNP2 cells expressing EGFR exon 20 duplication mutants, S768_D770dup and N771_H773dup, but not of EGFR exon 19 mutant, E746_A750del, showed the inverted growth pattern. Enhanced activation of the PI3K/AKT signaling pathway was observed in iNP2_S768_D770dup and iIP4 cells, while increased MAPK signaling was found in iNP2_N771_H773dup. Increased cell migration and invasion were found in all cells carrying EGFR mutations when compared to iNP2 cells, and this effect was inhibited by either PI3K or MEK inhibitor. Notably, iNP2 cells expressing the N771_H773dup mutant showed the highest migration and invasion abilities. These results suggest that specific mutations in EGFR exon 20 play a crucial role in SIP development, partially though hyper-activation of the PI3K/AKT and MAPK signaling pathways. This study presents the first in vitro model for SIP development, which could facilitate further investigations into SIP pathogenesis and preclinical studies for new therapeutic agents.

Two-hole trephination (Muntarbhorn) technique for a large frontal sinus osteoma: a case report.

OBJECTIVE: To present an alternative surgical option for frontal sinus osteoma. MATERIAL AND METHOD: A woman presented with a symptomatic large osteoma in right frontal sinus. Two-hole trephination was planned to remove the osteoma using nasal endoscope and a drill in each hole. RESULTS: The osteoma was drilled and removed transnasally. Two months later, two small fragments of osteoma were detected remaining in the lateral aspect of the sinus. The fragments were removed successfully with the same technique. The patient was asymptomatic six months postoperatively. CONCLUSION: Two-hole trephination technique or Muntarbhorn technique is an attractive option for frontal sinus osteoma.

Evaluating Endoscopic Ipsilateral Endonasal Corridor Approaches to the Anterolateral Wall of the Maxillary Sinus: A Computerized Tomography Study.

Introduction The endoscopic access to lesions in the anterolateral wall of the maxillary sinus is a challenging issue; therefore, the evaluation of access should be performed. Objective To assess the accessibility of three endoscopic ipsilateral endonasal corridors. Methods Three corridors were created in each of the 30 maxillary sinuses from 19 head cadavers. Accessing the anterolateral wall of the maxillary sinus was documented with a straight stereotactic navigator probe at the level of the nasal floor and of the axilla of the inferior turbinate. Results At level of the nasal floor, the prelacrimal approach, the modified endoscopic Denker approach, and the endoscopic Denker approach allowed mean radial access to the anterolateral maxillary sinus wall of 42.6 ± 7.3 (95% confidence interval [CI]: 39.9-45.3), 56.0 ± 6.1 (95%CI: 53.7-58.3), and 60.1 ± 6.2 (95%CI: 57.8-62.4), respectively. Furthermore, these approaches provided more lateral access to the maxillary sinus at the level of the axilla of the inferior turbinate, with mean radial access of 45.8 ± 6.9 (95%CI: 43.3-48.4) for the prelacrimal approach, 59.8 ± 4.7 (95% CI:58.1-61.6) for the modified endoscopic Denker approach, and 63.6 ± 5.5 (95%CI: 61.6-65.7) for the endoscopic Denker approach. The mean radial access in each corridor, either at the level of the nasal floor or the axilla of the inferior turbinate, showed a statistically significant difference in all comparison approaches ( p < 0.05). Conclusions The prelacrimal approach provided a narrow radial access, which allows access to anteromedial lesions of the maxillary sinus, whereas the modified endoscopic Denker and the endoscopic Denker approaches provided more lateral radial access and improved operational feasibility on far anterolateral maxillary sinus lesions.

Management of Traumatic and Non-Traumatic Cerebrospinal Fluid Rhinorrhea-Experience from Three Southeast Asian Countries.

BACKGROUND: Cerebrospinal fluid (CSF) rhinorrhea requires proper management to avoid disastrous consequences. The objectives of this study were to ascertain the patient characteristics, etiologies, sites of defect, skull base configurations, methods of investigation, and management outcomes of CSF rhinorrhea. METHODS: A retrospective study was performed over 4 years involving three surgeons from Malaysia, Singapore, and Thailand. Hospital records were reviewed to determine the patients' characteristics, the causes and sites of leaks, methods of investigation, skull base configurations, choices of treatment, and outcomes. RESULTS: A total of 15 cases (7 traumatic and 8 non-traumatic) were included. Imaging was performed in all cases. The most common site of leakage was the cribriform plate (9/15 cases). The mean ± SD of the Keros heights were 4.43 ± 1.66 (right) and 4.21 ± 1.76 mm (left). Type II Keros was the most common (60%). The mean ± SD angles of the cribriform plate slope were 51.91 ± 13.43 degrees (right) and 63.54 ± 12.64 degrees (left). A class II Gera configuration was the most common (80%). All except two patients were treated with endonasal endoscopic surgical repair, with a success rate of 92.3%. A multilayered repair technique was used in all patients except one. The mean ± SD postoperative hospital stay was 9.07 ± 6.17 days. CONCLUSIONS: Non-traumatic CSF rhinorrhea outnumbered traumatic CSF rhinorrhea, with the most common site of leak at the cribriform plate. Imaging plays an important role in investigation, and Gera classification appears to be better than Keros classification for evaluating risk. Both conservative and surgical repairs are practiced with successful outcomes. Endonasal endoscopic CSF leak repair is the mainstay treatment.

Voice quality changes after functional endoscopic sinus surgery in patients with nasal polyps.

Nasal polyps are associated with hyponasality. The effect of functional endoscopic sinus surgery (FESS) on voice quality has not been adequately investigated; therefore, this study developed objective and subjective measurements to compare nasal polyp patients pre- and postsurgery. An observational prospective study was conducted at Srinagarind Hospital, Khon Kaen University, Thailand. Bilateral nasal polyposis patients who underwent FESS between August 1, 2015 and August 1, 2017, were recruited. All participants were assessed for nasal polyp grade, nasometry, acoustic parameters, acoustic perception, and patient satisfaction before surgery and at the 1-, 3- and 6-month follow-ups. Forty-six patients, 29 males and 17 females (mean age 48.2 years ± 16.2 years), were enrolled. Mean nasometry scores were significantly improved at 1, 3 and 6 months after surgery (p < 0.05), whereas the acoustic parameters were not significantly different after surgery (p > 0.05). Overall acoustic perception, assessed with a set of words and sentences, showed significant improvement in hyponasality voice after surgery (p < 0.05), whereas GIRBAS showed no significant change after surgery in each parameter of perception (p > 0.05). Patient satisfaction with voice changes after surgery was high, with significantly increased mean scores between the 1- and 6-month follow-ups (p < 0.05). The results showed that FESS for nasal polyposis patients improved voice quality and patients' voice satisfaction ratings. Trial registration: This trial was registered at the Thai Clinical Trial Registry (TCTR20210324004).